Will Medicare Cover Doctor Visits?

Medicare Part B provides substantial coverage for services like doctor visits, preventative care, and mostly anything considered “medically necessary” for your treatment. There are, however, limits to Part B cost coverage for doctor visits that you should be aware of.

How Medicare Covers Doctor’s Visits

Medicare Part B is a part of Original Medicare. This coverage is extremely beneficial, but many benefits fall under the umbrella of “medically necessary” care. This just means that a Medicare-certified doctor approves and confirms that some treatment, item, etc., is required to treat your medical condition.

When it comes to doctor’s visits, once the cost is Medicare-approved and your doctor accepts the assignment, Part B will cover 80 percent.

Part B mostly covers outpatient care in settings like offices or clinics but may also include some inpatient services in a hospital.

Doctors’ visits aren’t just limited to direct treatment, however. Medicare Part B also covers preventive services you receive from your doctor or another medical provider, even if you haven’t paid your deductible. This includes wellness appointments, checkups, screenings, etc.

You will likely have to pay a copayment or coinsurance fee for your doctor’s visit. Also, don’t forget to pay your monthly Part B premium, which is currently $170.10 in 2022. While you won’t need to pay it for preventative visits, prepare to pay your Part B deductible each year when you receive care. It is set at $233 in 2022.

What Medicare Won’t Cover

While you may consider treatment or doctor’s visit “medically necessary,” Medicare has some exceptions that could influence the coverage you receive for your care. Part B coverage isn’t “set in stone,” so be sure to check before assuming Medicare will or won’t contribute to your costs.

Medicare Part B, for instance, does not cover dental, vision, or hearing checkups or equipment like glasses, dentures, or hearing aids. While most people rightfully assume that these are “medically necessary,” Medicare does not.

Part B also won’t cover excluded services like chiropractic care, cosmetics, or custodial care (i.e., assistance with everyday tasks like washing or eating).

There may be other medical visits and services that Medicare won’t cover. When in doubt, always check your policy or enrollment information.

Find Coverage Today

Even though Medicare coverage can be complicated, we’re here to help. Let’s take the next step towards your best health together. To get started, call ReLion Insurance Solutions at 858-999-2858.